Epidemiology of gingival & periodontal diseases in children

Epidemiology of
Gingival &
Periodontal Diseases
DR. SUSMITA S. SHAH
MDS PART II
1

Content
• Introduction
• Incidence & Prevalence
• Gingival Indices
• Periodontal Indices
• Conclusion
• Bibliography
Add a footer 2

Introduction
Epidemiology: It is the “study of the distribution and determinants of
health related states or events in a specified population, and the
application of this study to control of health problems.”{-John M.
Last(1988)}
As the definition implies , EPIDEMIOLOGY has three purposes:
1. To determine the amount and distribution of a disease in a population
2. To investigate the causes of disease
3. To apply this knowledge to the control of disease
Peter S. Essentials of preventive and community dentistry. Arya (Medi) Publishing House. 5th edition.123-231. 3

• For epidemiologist to study a disease in population or for clinician to
care for an individual patients, they must be able to identify individuals
with or without disease.
• Various diagnostic tests are used for making correct diagnosis of
diseases.
• They are:
• Sensitivity & Specificity
• Predictive Value
Peter S. Essentials of preventive and community dentistry. Arya (Medi) Publishing House.
5th edition.123-231. 5

SENSITIVITY & SPECIFICITY
• When a diagnostic tests for a disease or condition gives a positive
result, the result can be correct(true positive) or incorrect (false
negative).
• When a test gives a negative result the result can be true(true
negative) or false(false negative).
• The sensitivity of a test is the proportion of subjects with the disease
who test positive.
• The specificity of a test is the proportion of subjects without the
disease who tests negative.

PREDECTIVE VALUE
• The probability that a person with a positive test has the disease is
Positive predictive value of the test.
• The probability that a person with a negative test does not have the
disease is Negative predictive value of the test.

RISK VS PROGNOSIS
• Risk:
The likelihood that a person will get a disease in a specified time period is
risk
• Risk Factor:
The characteristics of a individuals that place them at increased risk for
getting a disease is risk factors.
• Risk Assessment:
The process of predicting an individual probability of a disease is risk
assessment.

• Prognosis:
It is the prediction course or outcome of the disease.
• Prognostic Factors:
The characteristics or factors that predict the outcome of a disease once
disease are present are prognostic factors.
• Prognostic Assessments:
The process of using prognostic factors, to predict the course of disease
is prognostic assessments.
Peter S. Essentials of preventive and community dentistry. Arya (Medi) Publishing
House. 5th edition.123-231. 9

EPIDEMIOLOGIC MEASURES OF
DISEASE
INCIDENCE
• It is defined as the number of new
cases of a specific disease occurring in
a defined population during a specified
period of time.
• Incidence=No. of new cases of a
specific disease during a given period
X 100
• It is of two types
• 1. Episode incidence
• 2. Cumulative Incidence
PREVALENCE
• The term disease prevalence is used
to indicate all current cases (both
old & new)
• existing in a given population at a
given point in time or over a period
of time.
• It is of two types:
• 1. Point prevalence
• 2. Period prevalence
5th edition.123-231. 10

Title Author &
Journal
LOE
Aim Materials and
method
Results Conclusion
The prevalence
gingivitis and
periodontal
diseases in
preschool
children in
Kolkata
Goswami S,
Saha S.
Indian Journal
of
Multidisciplinar
y dentistry.
Year: 2017,
Volume: 7,
Issue: 1, Page:
3-7.
to determine the
prevalence of
gingivitis and
periodontitis among
preschool children in
Kolkata.
A cross-sectional survey
of 200 children aged 2–
years were performed
from March 2015 to
February 2016. The
gingival index (GI) and
pocket depth of fully
erupted teeth were
measured
The comparison (t-test) of mean
depth was least (0.89 mm) between 3-
and 4-year-old children and was
(3.09 mm) between 2- and 4-year-old
children. The mean GI among boys
girls differ significantly (P < 0.001). The
boys had a higher GI and pocket depth
than girls the mean GI in school going
children was 0.67 ± 0.22 and in
nonschool going children, it was 1.189
± 0.12, and mean pocket depth was
2.05 ± 0.32 and 2.77 ± 0.55,
respectively. The mean GI and pocket
depth in children of upper and lower
socioeconomic condition differ
significantly.
Preschool children
in and around
Kolkata suffer from
varying degree of
gingival diseases,
and
preventive
programs are
needed to improve
their oral health.
Add a footer 11

WILLIAM M. M. JENKINS & PANOS N. PAPAPANOU. Epidemiology of periodontal
disease in children and adolescents. Periodontology 2000, Vol. 26, 2001, 16–32 12

Periodontitis in deciduous dentition
• 1. Loss of probing attachment studies
– In 1963, Jamison found that 159 out of 229 examined 5- to 14-year-old United
States children had at least one deciduous tooth, and 40 (25.2%) of these children
had loss of probing attachment affecting at least one deciduous tooth.
– The prevalence rates for 5- to 7-year-olds, 8- to 10-year-olds and 11- to 14-year-
olds were 26.9%, 25% and 20.8% respectively.
– Study done in Hungary(1987) revealed that, out of 200 extracted and stained
carious deciduous molars, 47% were affected by attachment loss 0.5 mm, mostly
on one or more of their proximal surfaces
disease in children and adolescents. Periodontology 2000, Vol. 26, 2001, 16–32
13

2. Bitewing radiography studies
– Sweeney et al. (1987), in a bitewing radiograph survey of 2264 5- to 10-year-old
United States children attending a dental school clinic, reported only a 0.8%
prevalence of marginal bone loss.
– survey of 3896 sets of bitewing radiographs, selected from 26 public dental clinics
in Sweden, Sjödin & Matsson (1994) found that the prevalence of marginal bone
loss at deciduous molars and at the distal surface of deciduous canines in 7-, 8-
and 9-year-old children was 2.0%, 3.1% and 4.5% respectively.
– Early-onset forms of periodontitis affect approximately 0.1% of white populations
and up to 2.6% of black populations.
disease in children and adolescents. Periodontology 2000, Vol. 26, 2001, 16–32 14

15
Title Author &
Journal
LOE
Aim Materials and method Results Conclusio
n
Prevalence
and predictors
of early
periodontal
disease among
adolescents
Baiju R M, Elbe
Peter, Nayar B R,
Varughese J M,
Varghese Journal
of Indian Society
of
Periodontology -
Volume 23, Issue
4, July-August
2019
to estimate the
prevalence
of periodontal
disease among
older
adolescent
students and
to analyze its
predictors as
part of an oral
health
assessment
survey
conducted in
Kerala
A multistage cluster sampling
was employed
among five districts of Kerala
to examine 1065 students in
the age group of 15–18 years
from government and
private schools of selected
urban and rural areas.
Sociodemographic and oral
health behavioral data,
modified Community
Periodontal Index, Oral
Hygiene Index Simplified, and
Dental Aesthetic Index were
taken. Descriptive
statistics and bivariate and
multivariate logistic regression
analyses were done to identify
the predictors of gingival
bleeding and periodontal
pockets.
The prevalence of gingival bleeding,
periodontal pockets, and loss of
attachment was 42%, 13.4%, and 2.7%,
respectively. In the adjusted multivariate
model for predictors of gingival
bleeding, rural location of residence,
studying in government schools, high
mother’s education and their working
status, orthodontic treatment need, oral
hygiene frequency, and poor oral
hygiene status emerged as significant
predictors of gingival bleeding. In the
multivariate model for periodontal
pockets, bleeding on probing emerged
as the strongest predictor with an odds
ratio of 12.85 when adjusted to poor
oral hygiene.
The prevalence of
early periodontal
disease among
adolescents is
significant.
Sociodemographic
factors, poor oral
hygiene, and
malocclusion are
significant
predictors for
periodontal disease
among adolescents.

Baiju R M, Elbe Peter, Nayar B R, Varughese J M, Varghese o. Prevalence & predictors of gingival and periodontal diseases
among adolescents Journal of Indian Society of Periodontology - Volume 23, Issue 4, July-August 2019
16

• When epidemiological data have been collected, the amount of disease
found has to be quantified by using indices.
• Many surveys have shown widespread nature of gingivitis in children; a
prevalence of over 80% has been reported.
• This is more common and prevalent in many Asian & African countries
than in USA.
Epidemiology, Etiology, prevention of periodontal diseases. Report of WHO scientific group. 1978. 18

INDICES USED FOR ORAL HYGIENE ASSESSMENT
1. ORAL HYGIENE INDEX
2. SIMPLIFIED ORAL HYGIENE INDEX
3. Plaque Index
4. TURESKY, GILMORE, GLICKMAN MODIFICATION OF THE QUIGLEY HEIN PLAQUE
INDEX.
5. PATIENT HYGIENE PERFORMANCE INDEX (PHP INDEX)
19
8/6/2021

1. ORAL HYGIENE INDEX (OHI)
• John C. Green and Jack R. Vermillion (1960)
• Simple and sensitive method
• It is composed of 2 components:
– Debris index (DI)
– Calculus index (CI)
20
8/6/2021
Peter S. Essentials of preventive and community dentistry. Arya (Medi) Publishing House. 5th edition.123-231

• Each segment is examined for debris or
calculus.
• From each segment, one tooth is used
for calculating the individual index, for
that particular segment.
• The tooth used for the calculation must
have the greatest area covered by debris
or calculus.
21
8/6/2021
5th edition.123-231

22
RULES OF ORAL HYGIENE INDEX
• Only fully erupted permanent teeth are scored.
• Third molars and incompletely erupted teeth are not scored because of the wide
variations in heights of clinical crowns.
• The buccal and lingual debris scores are both taken on the tooth in a segment having
the greatest surface area covered by debris.
• The buccal and lingual calculus scores are both taken on the tooth in a segment having
the greatest surface area covered by supragingival and subgingival calculus
8/6/2021 Peter S. Essentials of preventive and community dentistry. Arya (Medi) Publishing House. 5th edition.123-231

DEBRIS INDEX
SCORE CRITERIA
0 no debris or stain present
1 soft debris covering not more than 1/3rd the tooth
surface, or presence of extrinsic stains without
other debris regardless of the area covered
2 soft debris covering more than 1/3rd, but not
more than 2/3rd, of the exposed tooth surface
3 soft debris covering more than 2/3rd of the
exposed tooth surface
24
8/6/2021
5th edition.123-231

CALCULUS INDEX
25
SCORE CRITERIA
0 No calculus present
1 Supragingival calculus covering not more than 1/3 of the
exposed tooth surface
2 Supragingival calculus covering more than 1/3 but not
more than 2/3 the exposed tooth surface or presence of
individual flecks of subgingival calculus around the cervical
portion of the tooth or both.
3 Supragingival calculus covering more than 2/3 the
exposed tooth surface or a continuous heavy band of
subgingival calculus around the cervical portion of tooth
or both.
8/6/2021
5th edition.123-231

Calculation
• The buccal and lingual scores are totaled for
each segment and arch
• DI = B.S + L.S / No. of segments
• CI = B.S + L.S / No. of segments
• OHI = DI + CI
Interpretatio
n
• DI and CI range from 0-6
• Maximum score for all segments can be 36 for
debris or calculus
• OHI range from 0-12
• Higher the OHI, poorer is the oral hygiene of
patient
26
8/6/2021
Peter S. Essentials of preventive and community dentistry. Arya (Medi) Publishing House. 5th
edition.123-231

2. SIMPLIFIED ORAL HYGIENE
INDEX
• John C Greene and Jack R Vermillion in 1964.
• Only fully erupted permanent teeth are scored.
• Natural teeth with full crown restorations and surfaces reduced in height by caries or
trauma are not scored.
• An alternate tooth is then examined.
27
8/6/2021
5th edition.123-231

28
Index
tooth
Alternat
e tooth
16 17,18
11 21
26 27,28
36 37,38
31 41
46 47,48
8/6/2021 Peter S. Essentials of preventive and community dentistry. Arya (Medi) Publishing House. 5th edition.123-231

Calculation and Interpretation
• DI -S= Total score/ no of surfaces
• CI-S= Total score/ no of surfaces
• OHI -S= DI-S+ CI-S
• DI-S and CI-S range from 0-3
• OHI-S range from 0-6
29
8/6/2021
5th edition.123-231

INTERPRETATION
30
DI –S and CI-S
Good - 0.0-0.6
Fair – 0.7-1.8
Poor – 1.9 -3.0
OHI –S
Good - 0.0-1.2
Fair – 1.3- 3.0
Poor – 3.0 -6.0
8/6/2021
5th edition.123-231

Uses
• Widely used in epidemiological studies of periodontal diseases.
• Useful in evaluation of dental health education programs
• Evaluating the efficacy of tooth brushes.
• Evaluate an individual’s level of oral cleanliness.
31
8/6/2021
5th edition.123-231

3. Plaque index
• Developed by Silness and Loe H in 1964
More fully described by Loe H in 1967.
• Assesses the thickness of plaque at the cervical
margin of the tooth closest to the gums
• All four surfaces of index teeth are examined
• Distal-facial
• Facial
• Mesio-facial
• Lingual
32
8/6/2021
5th edition.123-231

• Each tooth is dried and examined visually using a mirror, an explorer, and
adequate light.
• The explorer is passed over the cervical third to test for the presence of
plaque.
• A disclosing agent may be used to assist evaluation.
• In 1967, Loe modified the criteria for score 1 as to exclude the application
of disclosing agent.
• Missing teeth are not substituted
33
8/6/2021
5th edition.123-231

Score Criteria
0 No Plaque
1
A film of plaque adhering to the free gingival margin and adjacent
area of tooth the plaque may be seen in situ only after application
of disclosing solution or by using probe on tooth surface
2
Moderate accumulation of soft deposits within the gingival pocket,
or the tooth and gingival margin which can be seen with the naked
eye
3
Abundance of soft matter within the gingival pocket and/or on the
tooth and gingival margin
34
8/6/2021
5th edition.123-231

Calculation
• Plaque index for area : 0-3 for each surface.
• Plaque index for a tooth : Scores added and then divided by four.
• Plaque index for group of teeth : Scores for individual teeth are added and then divided by
number of teeth.
• Plaque index for the individual : Indices for each of the teeth are added and then divided by the
total number of teeth examined.
• Plaque index for group : All indices are taken and divided by number of individual
35
8/6/2021
5th edition.123-231

Interpretation of Plaque index
Rating Scores
Excellent 0
Good 0.1-0.9
Fair 1.0-1.9
Poor 2.0-3.0
36
8/6/2021
5th edition.123-231

Uses
• Reliable technique for evaluating both mechanical anti plaque procedures and
chemical agents.
• Used in longitudinal studies and clinical trials.
37
8/6/2021
5th edition.123-231

4. TURESKY, GILMORE, GLICKMAN MODIFICATION OF
THE QUIGLEY HEIN PLAQUE INDEX
• Quigley and Hein in 1962 reported a plaque measurement that focused on the gingival
third of the tooth surface.
• Only facial surfaces of the anterior teeth were examined after using basic fuchsin
mouthwash as a disclosing agent.
• The Quigley - Hein plaque index was modified by Turesky, Gilmore and Glickman in
1970.
38
8/6/2021
5th edition.123-231

PROCEDURE
• Instruments used : Mouth mirror and disclosing agent
• Plaque is assessed on the labial, buccal and lingual surfaces of all the teeth after using
a disclosing agent.
• The index is based on a numerical score of 0 to 5.
• An index for the entire mouth is determined by dividing the total score by the
number of surfaces examined. Third molars are not included.
39
8/6/2021
5th edition.123-231

By Quigley AND HEIN
SCORE Criteria
0 No plaque
1 Flecks of stain in gingival margin
2 Definite line of plaque at gingival margin
3 Gingival third of surface
4 Two thirds of surface
5 Greater than two third of surface
8/6/2021
5th edition.123-231 40

Scoring system (modified by Turesky et
al)
41
8/6/2021
5th edition.123-231
Marwah N. Textbook of pediatric dentistry. Jaypee Brothers, Medical Publishers Pvt. Limited; 2018 Oct 31.
SCORE Criteria
0 No plaque
1 separate flecks of plaque at the cervical
margin of tooth
2 thin continuous band of plaque ( up to 1 mm)
3 band of plaque wider than 1 mm but covering
less than 1/3rd of the crown of the tooth
4 plaque covering at least 1/3rd but less than
2/3rd of the crown of the tooth.
5 plaque covering 2/3rd or more of the crown of
the tooth.

CALCULATION AND INTERPRETATION
• Index score = total score /
number of surfaces
examined
42
Score Interpretati
on
0 or 1 Low
2 or more high
Uses :
It provides a comprehensive method for evaluating anti-
plaque procedures such as tooth brushing and flossing, as
well as chemical anti-plaque agents.
8/6/2021
5th edition.123-231

5. PATIENT HYGIENE PERFORMANCE
INDEX (PHP INDEX)
• It was developed by Podshadley AG, and Haley JV (1968) to assess
the extent of plaque and debris over a tooth surface as an indication of
oral cleanliness.
• Most useful for individual patients who have significant plaque
accumulation.
8/6/2021

Procedure
8/6/2021
Peter S. Essentials of preventive and community dentistry. Arya (Medi) Publishing House. 5th edition.123-231
44
• Disclosing solution is applied.
• Patient is asked to swish for 30 seconds
and expectorate
• Examination is made using a mouth
mirror.

• Each tooth surface to be evaluated is
subdivided into five sections as follows.
• Vertically: Three divisions mesial,
middle and distal.
• Horizontally: The middle third is
subdivided into gingival, middle and
occlusal or incisal thirds.
• Each area with plaque is scored a point
so each tooth score can range from 1 to
5 points
8/6/2021
• Each of the 5 subdivisions is scored for
presence of stained debris:
0= no debris(or questionable)
1= debris definitely present

• Debris score for individual tooth = Add the scores for each of the 5 subdivisions.
• PHP index for an individual = Total score for all the teeth divided by the number of teeth examined.
• RATING SCORES:
Excellent : 0 (no debris)
Good : 0.1-1.7
Fair : 1.8 – 3.4
Poor : 3.5 – 5.0
8/6/2021

Gingival and Periodontal Disease Indices
a. Gingival Index
b. Periodontal Index
c. Papillary-Marginal-Attachment Index
d. Periodontal disease Index (PDI)
e. CPITN
47
8/6/2021
5th edition.123-231

a. Gingival Index
• Developed by Loe H and Silness J in 1963.
• widely accepted and used
• Assess the severity of gingivitis and its location in 4 possible areas.
– Mesial
– Lingual
– Distal
– Facial
• Only qualitative changes are assessed.
48
8/6/2021
5th edition.123-231

• All surfaces of all teeth or selected teeth are scored.
• The selected teeth as the index teeth are 16,12,24,36,32,44.
• The teeth and gingiva are first dried with a blast of air and/or cotton rolls.
• The tissues are divided into 4 gingival scoring units: disto-facial papilla, facial margin, mesio-facial
papilla and entire lingual margin.
• A blunt periodontal probe (William’s probe) is used to assess the bleeding potential of the
tissues.
49
METHOD:
8/6/2021
5th edition.123-231

SCORE CRITERIA
0 Absence of inflammation/normal gingiva
1
Mild inflammation, slight change in color, slight
edema, no bleeding on probing
2
Moderate inflammation, moderate glazing,
redness, edema and hypertrophy. bleeding on
probing
3
Severe inflammation, marked redness and
hypertrophy ulceration. Tendency to
spontaneous bleeding.
50
8/6/2021
5th edition.123-231

• If the scores around each tooth are totaled and divided by the number of surfaces per tooth
examined (4), the gingival index score for the tooth is obtained.
• Totaling all of the scores per tooth and dividing by the number of teeth examined provides
the gingival index score for individual.
• Interpretation
• 0.1 - 1.0 : Mild gingivitis
• 1.1 – 2.0 : Moderate gingivitis
• 2.1 – 3.0 : Severe gingivitis
51
8/6/2021
5th edition.123-231

b. Periodontal Index
• Developed by Rusell A. L. in 1956.
• It was intended to estimate deeper periodontal disease by maintaining the presence or absence of gingival
inflammation and its severity, pocket formation and masticatory function.
• It was once widely used in epidemiological surveys but not used much now because of introduction of new
periodontal indices and refinement of criteria.
• The PI is reported to be useful among large populations, but it is of limited use for individuals or small groups.
52
8/6/2021
5th edition.123-231

• All the teeth are examined in this index for gingival inflammation and periodontal involvement.
• Instruments used : Mouth mirror and plain probe
• Russell chose the scoring values as 0,1,2,6,8 in order to relate the stage of the disease in an epidemiological survey to
the clinical conditions observed.
• The Russell’s rule states that “ when in doubt assign the lower score.”
53
8/6/2021
5th edition.123-231

54
Sc
ore
Criteria Additional Radiographic Features
0 Negative. Neither overt inflammation in the investing tissues nor loss
of function due to destruction of supporting bone.
Radiographic appearance is essentially normal.
1 Mild gingivitis. An overt area of inflammation in the free gingiva does
not circumscribe the tooth
2 Gingivitis. Inflammation completely circumscribe the tooth, but there
is no apparent break in the epithelial attachment
4 Used only when radiographs are available. There is early notch like resorption of alveolar crest.
6 Gingivitis with pocket formation. The epithelial attachment is
broken and there is a pocket. There is no interference with normal
masticatory function; the tooth is firm in its socket and has not drifted.
There is horizontal bone loss involving the entire alveolar crest, up to
half of the length of the tooth root.
8 Advanced destruction with loss of masticatory function. The tooth
may be loose, may have drifted, may sound dull on percussion with
metallic instrument, or may be depressible in its socket.
There is advanced bone loss involving more than half of the tooth
root, or a definite intrabony pocket with widening of periodontal
ligament. There may be root resorption or rarefaction at the apex.
8/6/2021
edition.123-231

• PI score per person = Sum of individual scores / No. of
teeth present
55
Clinical Condition Individual Scores
Clinical normally supportive tissue 0.0-0.2
Simple gingivitis 0.3-0.9
Beginning destructive periodontal
diseases
1.0-1.9
Established destructive periodontal
disease
2.0-4.9
Terminal disease 5.0-8.0
8/6/2021
5th edition.123-231

c. Papillary-marginal-attachment
index
• Developed by Schour I and Massler M (1944)
• The basic physiology used for development of this index was
that, here the number of gingival units affected were counted
rather than severity of the inflammation
56
8/6/2021
5th edition.123-231

• A gingival unit was divided into three component parts.
1. Papillary gingiva
2. Marginal gingiva
3. Attached gingiva
• The presence or absence of inflammation on each gingival unit is recorded respectively.
• Although all facial tissues surrounding all the teeth could not be assessed in this manner, usually only
the maxillary and mandibular incisors, canine’s and premolars are examined.
• In general, mild gingivitis is confined to papillary area, moderate gingivitis means spread to marginal
Gingiva and Severe gingivitis is defined by it’s spread to attached gingiva
57
8/6/2021
5th edition.123-231

Papillary = P
0 = Normal, no inflammation.
1+ = Mild papillary engorgement, slight
increase in size.
2+ = Obvious increase in size of gingival
papilla, bleeding on pressure.
3+ = Excessive increase in size with
spontaneous bleeding
4+ = Necrotic papilla.
5+ = Atrophy and loss of papilla (through
inflammation).
8/6/2021
 Marginal = M
0 = Normal, no inflammation visible.
1+ = Engorgement, slight increase in size, no
bleeding.
2+ = Obvious engorgement, bleeding upon
pressure
3+ = Swollen collar, spontaneous bleeding,
beginning infiltration into attached gingiva.
4+ = Necrotic gingivitis.
5+ = Recession of the free marginal gingiva
below the cementoenamel junction as a
result of inflammatory changes.

Add a footer 59
Attached = A
0 = Normal; pale rose, stippled
1+ = Slight engorgement with loss of stippling, change in color may or may not be
present.
2+ = Obvious engorgement of attached gingiva with marked increase in redness, pocket
formation present
3+ = Advanced periodontitis, deep pockets evident.

CALCULATION
• The number of affected papillary, marginal and attached units are
counted and the P, M and A numerical values are totalled separately,
then added together and expressed numerically as the PMA index score
per individual.
• Total score (PMA) = P + M + A
8/6/2021

d. Periodontal Disease Index (PDI)
• The periodontal disease index was introduced by Sigurd P Ramfjord in
1959
• It was a modification of Russell index
• Particularly designed for assessing the level of the periodontal
attachment related to the cementoenamel junction of the teeth
61
8/6/2021
5th edition.123-231

Components
• Composed of three components:
I. Plaque component
Ii. Calculus component and
Iii. Gingival & periodontal component.
62
8/6/2021
5th edition.123-231

• All the three components will be scored separately using six Ramfjord selected
teeth.
1. Maxillary right first molar - (16)
2. Maxillary left central incisor - (21)
3. Maxillary left first bicuspid - (24)
4. Mandibular left first molar - (36)
5. Mandibular right central incisor - (41)
6. Mandibular right first bicuspid - (44)
• The surfaces scored are: facial, lingual, mesial and distal
63
8/6/2021
5th edition.123-231

i. PLAQUE COMPONENT
64
SCORE CRITERIA
0 No plaque
1 Plaque present on some but not on all interproximal, buccal, and
lingual surfaces of the tooth
2 Plaque present on all interproximal, buccal, and lingual surfaces, but
covering less than one half of these surfaces
3 Plaque extending over all interproximal, buccal and lingual surfaces,
and covering more than one half of these surfaces
8/6/2021
5th edition.123-231
• Instruments used :
Mouth mirror and
dental explorer
• Disclosing agent used
: Bismark brown

ii. CALCULUS COMPONENT:
65
SCORE CRITERIA
0 No calculus
1 Supragingival calculus extending only slightly below the free gingival
margin (not more than 1 mm)
2 Moderate amount of supragingival and sub gingival calculus or sub-
gingival calculus alone.
3 An abundance of supra gingival and sub gingival calculus
8/6/2021
5th edition.123-231
• Instruments used -
Mouth mirror and dental
explorer

iii. GINGIVAL AND PERIODONTAL
COMPONENT:
• Gingival status is scored first.
• Gingival status and crevice depth is recorded in relation to CEJ
• All areas (M, D, B, L) is scored.
• Only fully erupted teeth are scored.
• There is no substitution for excluded teeth.
• The gingiva is first dried gently by touching with absorbing cotton and then examined.
• Instrument used : Mouth mirror and University of Michigan number 0 probe
66
8/6/2021
5th edition.123-231

67
SCOR
E
CRITERIA
0 Absence of signs of inflammation
1 Mild to moderate inflammatory gingival changes not extending around the tooth
2 Mild to moderately severe gingivitis extending all around the tooth
3 Severe gingivitis characterized by marked redness, swelling, tendency to bleed, and
ulceration
4 Gingival crevice in any of 4 measured areas(M,D,B,L) extending apically to CEJ but not
more than 3mm
5 Gingival crevice in any of 4 measured areas(M,D,B,L) extending apically to CEJ
between 3-6mm
6 Gingival crevice in any of 4 measured areas(M,D,B,L) extending apically more than
6mm from CEJ
8/6/2021
5th edition.123-231

Scoring PDI
• For individuals: Add the scores for individual teeth and divide by the
number of teeth examined. The PDI ranges from 0 to 6.
• For group: Total the individual PDI scores and divide by the number of
individuals examined. The average ranges from 0 to 6
69
8/6/2021
5th edition.123-231

Modification of plaque criteria
• The original criteria of the plaque component of periodontal index (PDI)
was modified by Shick R.A and Ash M.M in 1961.
• It consists of examining the six index teeth excluding the interproximal
areas of the teeth and restricting the scoring of plaque to the gingival
half, of the facial and lingual surfaces of the index teeth.
8/6/2021

Scoring
Score Criteria
0 Absence of dental plaque
1 Dental plaque at the gingival margin covering less than one third of the gingival half
of the facial or lingual surface of the tooth
2 Dental plaque covering more than 1/3rd but less than 2/3rd of the gingival half of the
facial or lingual surface of the tooth
3 Dental plaque covering 2/3rd or more of the gingival half of the facial or lingual
surface of the tooth
8/6/2021

Calculation
• The plaque score per person is obtained by totalling all of the
individual tooth scores and dividing by the number of teeth
examined.
• Plaque score = Total score / no. of teeth examined
8/6/2021

e. Community Periodontal Index of
Treatment Needs (CPITN)
• The community periodontal index of treatment needs was developed by
Ainamo et al the joint working committee of the WHO and FDI in 1982.
• Developed primarily to survey and evaluate periodontal treatment needs
rather than determining past and present periodontal status i.e. recession of
the gingival margin and alveolar bone.
73
8/6/2021
5th edition.123-231

74
• Procedure :
– The mouth is divided into sextants :
– The 3rd molars are not included, except where they are functioning in place of 2nd
molars.
– The treatment need in a sextant is recorded only if there are 2 or more teeth
present in a sextant and not indicated for extraction. If only one tooth remains in a
sextant, then the tooth is included in the adjoining sextant.
8/6/2021
edition.123-231
17- 14 13- 23 24- 27
47 – 44 43- 33 34 – 37

75
• Probing depth is recorded either on all the teeth in a sextant or only on certain indexed
teeth as recommended by WHO for epidemiological surveys.
• FOR ADULTS AGED > 20 yrs:
– 10 index teeth are taken into account :17/16, 11, 26/27, 47/46, 31, 36/37.
– The molars are examined in pairs and only one score, the highest score is recorded.
• For young people up to 19 yrs:
– Only 6 index teeth are examined : 16, 11, 26, 46, 31, 36
– The second molars are excluded at these ages because of the high frequency of
false pockets (non inflammatory tooth eruption associated).
8/6/2021
edition.123-231

• When examining children less than 15 yrs, pockets are not
recorded although probing for bleeding and calculus are
carried out as a routine.
• CPITN PROBE :
– First described by WHO.
• Designed for 2 purposes :
– Measurement of pockets.
– Detection of sub-gingival calculus.
76
8/6/2021
5th edition.123-231

77
CO
DE
CRITERIA TREATMENT
NEEDS
0 Healthy periodontium TN-0 No need of treatment
1 Bleeding observed during / after
probing
TN-1 Self care
2 Calculus or other plaque retentive
factors seen or felt during probing
TN-2 Professional care
3 Pathological pocket 4-5 mm. gingival
margin situated on black band of the
probe.
TN-2 Scaling and root
planning
4 Pathological pocket 6mm or more.
Black band of the probe not visible
TN-3 Complex therapy by
specially trained
personnel
8/6/2021
edition.123-231

f. COMMUNITY PERIODONTAL
INDEX (CPI)
• It is a modification of CPITN index.
• The modification is done by inclusion of measurement of ‘loss of
attachment’ and elimination of the ‘treatment needs’ category.
8/6/2021

8/6/2021
edition.123-231 79
Instruments used : Mouth mirror and CPITN-C probe
SCORE CRITERIA
0 Healthy
1 Bleeding observed, after probing
2 Calculus detected during probing, but all of the
black band on the probe is visible
3 Pocket depth 4-5 mm (gingival margin within the
black band on the probe)
4 Pocket depth 6 mm or more (black band on the
probe is not visible)
X Excluded sextant (less than two teeth present)
9 Not recorded

ISRN Dentistry Volume 2013, Article ID 352621, 7 pages 82

Reliability, Sensitivity and Statistical Analysis of
Indices of Gingival and Periodontal Disease
• The reliability of the various indices for gingival and periodontal
disease have been studied to some extent in the literature. Lack of
inter-examiner reliability has been demonstrated by, Davies et al; as
part of an epidemiological training course.
• In this study the index proposed by Russell was used and the results
clearly indicate that without any calibration or training the inter-
examiner reliability was low.
• Studies conducted by Smith et al., Alexander et al(1975) and Shaw
& Murray(1976) have shown that training programs can be effective
in reducing inter-examiner as well as intra-examiner agreement in
recording gingivitis.
Sven Poulsen, Dr Odont. Epidemiology and indices of gingival and periodontal disease. PEDIATRIC DENTISTRY. by The
American Academy of Pedodontics. Vol. 3, Special Issue.
84

Bibliography
• Peter S. Essentials of preventive and community dentistry. Arya (Medi)
Publishing House. 5th edition.123-231.
• Marwah N. Textbook of pediatric dentistry. Jaypee Brothers, Medical
Publishers Pvt. Limited; 2018 Oct 31.
• Wei SH, Lang KP. Periodontal epidemiological indices for children and
adolescents: I. gingival and periodontal health assessments. Pediatr Dent.
1981 Dec;3(4):353-60.
• Lang NP. Periodontal epidemiological indices for children and adolescents: II.
Evaluation of oral hygiene; III. Clinical applications. Pediatric dentistry. 1982
Mar;4(1):65.
• Wei S. Periodontal epidemiological indices for children and adolescents.
Pediatric Dentistry AAPD Vol. 3, no. 4:1981.
Add a footer 85

• Sven Poulsen, Dr Odont. Epidemiology and indices of gingival and periodontal
disease. PEDIATRIC DENTISTRY. by The American Academy of Pedodontics. Vol. 3,
Special Issue.
• Suchetana Goswami, Subrata Saha. The prevalence of gingivitis and periodontal
diseases in preschool children in Kolkata. Indian Journal of Multidisciplinary dentistry.
2017, Volume: 7, Issue: 1, Page: 3-7.
• Epidemiology, Etiology, prevention of periodontal diseases. Report of WHO scientific
group. 1978.
• WILLIAM M. M. JENKINS & PANOS N. PAPAPANOU. Epidemiology of periodontal
disease in children and adolescents. Periodontology 2000, Vol. 26, 2001, 16–32.
• Baiju R M, Elbe Peter, Nayar B R, Varughese J M, Varghese o. Journal of Indian Society
of Periodontology - Volume 23, Issue 4, July-August 2019
• Muhammad Ashraf Nazir. Prevalence of periodontal disease, its association with
systemic diseases and prevention. International Journal of Health Sciences. Vol. 1,
Issue 2, April-June 2017.
• AGUILAR E D, PAUL I, THORNTON-EVANS G, PETERSEN P. Recording and surveillance
systems for periodontal diseases. Periodontology 2000, Vol. 60, 2012, 40–53
Add a footer 86

Epidemiology of gingival & periodontal diseases in children

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Epidemiology of gingival & periodontal diseases in children

Similar to Epidemiology of gingival & periodontal diseases in children (20)

More from DrSusmita Shah

More from DrSusmita Shah (12)

Recently uploaded

Recently uploaded (20)

Epidemiology of gingival & periodontal diseases in children

Editor's Notes